Provider Demographics
NPI:1639805294
Name:HUDGENS, SELENA J
Entity Type:Individual
Prefix:
First Name:SELENA
Middle Name:J
Last Name:HUDGENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17905 MAINE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48212-1019
Mailing Address - Country:US
Mailing Address - Phone:313-600-8432
Mailing Address - Fax:
Practice Address - Street 1:17905 MAINE ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48212-1019
Practice Address - Country:US
Practice Address - Phone:313-733-4428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-26
Last Update Date:2023-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care